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Oscar Health // health insurance
 
New York City    Posted: Friday, November 20, 2020
 
   
 
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JOB DETAILS
 

Hi, we're Oscar. Were hiring an Investigative Sr. Analyst to join our SIU team in our New York City office. 

Oscar is a technology-driven, consumer-focused health insurance startup founded in 2012 & headquartered in New York City. Our goal is to make health insurance simple, transparent, & human. We need your help to do so.

About the role:

The SIU runs or coordinates activities across Oscar to reduce the incidence & impact of fraud, waste, and/or abuse (FWA) on all our operations. 

Within the SIU, your primary role will be to support Oscar in its fight against fraud.  Joining this dynamic team will expose you to the latest trends & patterns in FWA across the healthcare industry & provide you with the chance to fight this FWA using sophisticated analytical tools & big data.  Your work will not only lead to savings & recoupments for Oscar as a company, but to more affordable & higher-quality health care for the members we serve.

You will report into the SIU Director, who reports to the Compliance Officer.

Responsibilities:

  • Develop & expand your knowledge of FWA trends & schemes to efficiently intake & evaluate reports of FWA received by the SIU.  Review data & gather evidence to assign priority levels, assess reporting obligations based on state(s) impacted, & maintain a pipeline of investigations into known or suspected FWA to be assigned to the investigators.
  • Coordinate & fulfill responses to Requests for Information (RFI), Subpoenas, Regulators, & internally received within the SIU.
  • Coordinate & complete assigned annual reportings & filings ensuring required responses are received within deadlines.
  • Conduct preliminary investigations of out of network providers, including reviewing data, building a case file, gathering evidence, & recommending next steps.
  • Provide support to investigators as requested to include performing interviews of members & contacting providers.
  • Gather & prepare reporting as assigned for internal use.

Requirements:

  • Bachelors degree in Criminal Justice, Business or similar
  • 2+ years of health insurance experience
  • Experience handling confidential information & adhering to policies, rules, & regulations
  • Highly organized with a high level of attention to detail
  • Enjoy complex problem solving & are willing to consider multiple possible solutions or causes.

Bonus points:

  • Certification applicable to this work such as Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified AML [Anti-Money Laundering] & Fraud Professional (CAFP), Certified Professional Coder (CPC) or similar
  • Knowledge of applicable fraud statutes & regulations, & of federal guidelines on recoupments & other anti-FWA activity
  • Experience specifically with claims processing, billing, reimbursement, or provider contracting.
  • Experience with HIPAA, data privacy, and/or data security processes
  • Experience working with regulators governing (public or private) health insurance carriers

Life at Oscar: 

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves & find both belonging & support. We're on a mission to change health care -- an experience made whole by our unique backgrounds & perspectives.

We encourage our members to care for their whole selves, & we encourage our employees to do the same with comprehensive medical benefits, generous paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, & volunteer opportunities.

Reasonable Accommodation:

Oscar applicants are considered solely based on their qualifications, without regard to applicants disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

Pay Transparency Policy:

Oscar ensures that you won't be discharged or discriminated against based on whether you've inquired about, discussed, or disclosed your pay. Read the full policy here.

 
 
 
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